Study Documents Recent Surge in Number of Medically Disenfranchised Americans

The number of medically disenfranchised Americans, defined as individuals without a regular source of preventive and primary health care, jumped by 4 million people during the past two years, says a new report from the National Association of Community Health Centers, or NACHC. The increase brings the nation's medically disenfranchised population to 60 million.

According to the report, Primary Care Access: An Essential Building Block of Health Reform, (28-page PDF; About PDFs) "The effects of a severely stressed economy have far-reaching consequences for our nation and, indeed, our public health. Massive layoffs and job losses are swelling the ranks of the uninsured and leaving states with shrinking budgets and difficult choices. For every 1 percent increase in unemployment, more than 1 million people lose their health insurance and another million people enroll in Medicaid and the State Children's Health Insurance Program."

"The number of (medically) disenfranchised Americans has grown three times faster than the general population during the past two years," said Dan Hawkins, senior VP for policy and programs at NACHC, during a press conference here on March 24. "Clearly, this is a signal that primary care access is worsening here in America. That number would have been even higher if not for the fact that (community) health centers added 2 million new patients to their rolls during that same period of time."

According to the report, more individuals are reporting difficulty finding a physician. "Very often the medically disenfranchised are people who routinely negotiate barriers of distance, time and cost to find physician services outside of their communities because there are few or none available where they live," the report notes. The lack of primary care physician services within these communities often leads to poorer health outcomes because these individuals do not have access to coordinated primary care services.

Expansion of primary care services for the medically disenfranchised can be helped by expanding the number of community health centers, or CHCs, says the report. "The very populations that would most benefit from primary care are the same populations targeted by the national network of community health centers."

In fact, according to the report, CHCs provide care to more than 18 million Americans in 7,000 communities across the United States. Most CHC patients live on incomes below 200 percent of the federally designated poverty threshold and are members of minority groups who are either uninsured or publicly insured.

However, keeping pace with the escalating demand and need for care in these communities and among these patients is a challenge, especially during difficult economic times, said Hawkins.

The recent enactment of the American Recovery and Reinvestment Act, or ARRA, which contains $2 billion in funding for CHCs, will help the clinics expand their coverage, Hawkins said. But, according to the report, "the increased demand for primary care that comes from expanding coverage must be met with an augmented primary care infrastructure."

During the press conference, Hawkins pointed to Massachusetts as an example of the importance of the primary care infrastructure. Massachusetts mandated insurance coverage for everyone in the state a few years ago, but government officials quickly learned that the state does not have enough primary care health professionals to meet the increased demand, said Hawkins.

This has put an enormous strain on the state's primary care infrastructure and, in particular, its network of CHCs, said Hawkins. Although CHCs supplied care to one in five uninsured Massachusetts residents before the state mandated universal coverage, they now provide care to one in three uninsured residents in the state, he said.

Health care reform and continued targeted investment can make significant and meaningful improvements in the accessibility and quality of primary care, says the report, which suggests four steps to produce a higher-performing national health care system with primary care at the center. These four steps are

Although the expansion of insurance coverage is a "vital step," says the report, health care expansion can only take the country so far. Ensuring that the United States has a quality health care system also depends on patients being able to get access to a usual source of care. "Primary care must therefore be the foundation on which national health reform takes shape," says the report. "To make this happen, policymakers must invest in the development of a primary care workforce and primary care facilities, equipment and health information technology. They must also bring about payment reforms that reward results and quality improvements, as well as support care coordination."